WHO recommendations for induction of labour

Published by World Health Organization on Apr 9, 2025

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Abstract

Language

en-gb

PICOS

PICO 10.1

Population
Women at or beyond term (by gestational age)
Intervention
Induction of labour
Comparator
Expectant management
Outcomes

PICO 10.1

Population
women with uterine hyperstimulation during induction of labour
Intervention
Tocolytics
Comparator
no treatment
Outcomes

PICO 10.1

Population
Women at term
Intervention
Oxytocin alone
Comparator
Expectant management/ placebo
Outcomes

PICO 10.1

Population
Outpatient versus inpatient induction of labour for improving birth outcomes
Intervention
Outpatient induction with vaginal prostaglandin E2
Comparator
Inpatient induction with vaginal prostaglandin E2
Outcomes

PICO 10.2

Population
women with uterine hyperstimulation during induction of labour
Intervention
Terbutaline
Comparator
Magnesium sulphate
Outcomes

PICO 10.2

Population
Outpatient versus inpatient induction of labour for improving birth outcomes
Intervention
Outpatient induction with controlled release prostaglandin E2
Comparator
Inpatient induction with controlled release prostaglandin E2
Outcomes

PICO 10.2

Population
Women at term
Intervention
Oxytocin alone
Comparator
Intracervical PGE2
Outcomes

PICO 10.3

Population
women with uterine hyperstimulation during induction of labour
Intervention
Terbutaline
Comparator
Nitroglycerin
Outcomes

PICO 10.3

Population
Women at term
Intervention
Oxytocin alone
Comparator
Vaginal PGE2
Outcomes

PICO 10.4

Population
women with uterine hyperstimulation during induction of labour
Intervention
Atosiban
Comparator
Betamimetics
Outcomes

PICO 10.4

Population
Women at term
Intervention
Oxytocin alone
Comparator
Vaginal PGFalpha
Outcomes

PICO 10.5

Population
women with uterine hyperstimulation during induction of labour
Intervention
Tocolytics
Comparator
Emergent delivery
Outcomes

PICO 10.5

Population
Women at term
Intervention
IV (intravenous) oxytocin and amniotomy
Comparator
Expectant management/ placebo
Outcomes

PICO 10.6

Population
Women at term
Intervention
Intravenous oxytocin and amniotomy
Comparator
Vaginal prostaglandin
Outcomes

PICO 10.7

Population
Women at term
Intervention
Intravenous oxytocin and amniotomy
Comparator
Intracervical prostaglandin
Outcomes

PICO 10.8

Population
Women at term
Intervention
IV oxytocin and amniotomy
Comparator
Oxytocin alone
Outcomes

PICO 10.9

Population
Women at term
Intervention
IV oxytocin and amniotomy
Comparator
Amniotomy alone
Outcomes

PICO 20.1

Population
Women with gestational diabetes
Intervention
Induction of labour
Comparator
Expectant management
Outcomes

PICO 20.1

Population
Women at term
Intervention
Vaginal misoprostol
Comparator
Expectant management/placebo
Outcomes

PICO 20.2

Population
Women at term
Intervention
Vaginal misoprostol
Comparator
Vaginal prostaglandin
Outcomes

PICO 20.3

Population
Women at term
Intervention
Vaginal misoprostol
Comparator
Intracervical prostaglandin
Outcomes

PICO 20.4

Population
Women at term
Intervention
Vaginal misoprostol
Comparator
Oxytocin
Outcomes

PICO 20.5

Population
Women at term
Intervention
Low-dose misoprostol
Comparator
High-dose misoprostol
Outcomes

PICO 20.6

Population
Women at term
Intervention
Misoprostol gel
Comparator
Misoprostol tablet
Outcomes

PICO 20.7

Population
Women at term
Intervention
Oral misoprostol
Comparator
placebo
Outcomes

PICO 20.8

Population
Women at term
Intervention
Oral misoprostol
Comparator
oxytocin
Outcomes

PICO 20.9

Population
Women at term
Intervention
Oral misoprostol
Comparator
vaginal misoprostol
Outcomes

PICO 20.10

Population
Women at term
Intervention
Oral misoprostol
Comparator
Intracervical prostaglandin
Outcomes

PICO 20.11

Population
Women at term
Intervention
Oral misoprostol
Comparator
Vaginal PG
Outcomes

PICO 20.12

Population
Women at term
Intervention
Oral misoprostol 50 mcg
Comparator
100 mcg
Outcomes

PICO 20.13

Population
Women at term
Intervention
Oral misoprostol Up to 4-hourly
Comparator
Oral misoprostol 6-hourly
Outcomes

PICO 20.14

Population
Women at term
Intervention
Oral misoprostol 3-hourly
Comparator
Oral misoprostol two doses, then routine oxytocin
Outcomes

PICO 20.15

Population
Women at term
Intervention
Oral 25 μg versus
Comparator
Vaginal 25 μg misoprostol
Outcomes

PICO 20.16

Population
Women at term
Intervention
Oral misoprostol 25ug
Comparator
Vaginal PG
Outcomes

PICO 20.17

Population
Women at term
Intervention
Subligual/buccal
Comparator
vaginal misoprostol
Outcomes

PICO 20.18

Population
Women at term
Intervention
Subligual/buccal misoprostol
Comparator
Oral misoprostol
Outcomes

PICO 30.1

Population
Women with suspected fetal macrosomia
Intervention
Induction
Comparator
Expectant management
Outcomes

PICO 30.1

Population
Women at term
Intervention
Prostaglandin E2 (all regimens)
Comparator
Placebo/no treatment
Outcomes

PICO 30.2

Population
Women at term
Intervention
Prostaglandin F2 α
Comparator
Placebo
Outcomes

PICO 30.3

Population
Women at term
Intervention
Prostaglandin F2
Comparator
Prostaglandin E2
Outcomes

PICO 30.4

Population
Women at term
Intervention
Prostaglandin E2 gel
Comparator
Prostaglandin E2 tablets
Outcomes

PICO 30.5

Population
Women at term
Intervention
Prostaglandin E2 gel
Comparator
Prostaglandin E2 suppository/ pessary
Outcomes

PICO 30.6

Population
Women at term
Intervention
Prostaglandin E2 tablet
Comparator
Prostaglandin E2 pessary/ suppository
Outcomes

PICO 30.7

Population
Women at term
Intervention
Prostaglandin E2 (controlled release)
Comparator
All prostaglandin E2 delivery systems
Outcomes

PICO 30.8

Population
Women at term
Intervention
Prostaglandin E2 low dose
Comparator
Prostaglandin E2 high dose
Outcomes

PICO 30.9

Population
Women at term
Intervention
Oral prostaglandin
Comparator
Placebo or no treatment
Outcomes

PICO 30.10

Population
Women at term
Intervention
Oral prostaglandin
Comparator
Intravenous oxytocin
Outcomes

PICO 30.11

Population
Women at term
Intervention
Oral prostaglandin
Comparator
intracervical prostaglandin
Outcomes

PICO 30.12

Population
Women at term
Intervention
Oral prostaglandin
Comparator
vaginal prostaglandin
Outcomes

PICO 30.13

Population
Women at term
Intervention
Oral prostaglandin high/incremental dose
Comparator
Oral prostaglandin low dose
Outcomes

PICO 30.14

Population
Women at term
Intervention
Intracervical prostaglandin (PGE2)
Comparator
Placebo/no treatment
Outcomes

PICO 30.15

Population
Women at term
Intervention
Intracervical prostaglandin (PGE2)
Comparator
intravaginal prostaglandin (PGE2)
Outcomes

PICO 30.16

Population
Women at term
Intervention
Intracervical prostaglandin E2, low dose
Comparator
Intracervical prostaglandin E2, high dose
Outcomes

PICO 40.1

Population
Women at term
Intervention
Laminaria tent
Comparator
Placebo/ no treatment
Outcomes

PICO 40.1

Population
Women with prelabour rupture of membranes at term
Intervention
Induction of labour
Comparator
Expectant management
Outcomes

PICO 40.2

Population
Women with prelabour rupture of membranes at term
Intervention
Oxytocin
Comparator
Expectant management/placebo
Outcomes

PICO 40.2

Population
Women at term
Intervention
Laminaria tent
Comparator
Prostaglandins
Outcomes

PICO 40.3

Population
Women at term
Intervention
Laminaria tent and prostaglandins
Comparator
Prostaglandins alone
Outcomes

PICO 40.3

Population
Women with prelabour rupture of membranes at term
Intervention
Prostaglandin
Comparator
Expectant management/placebo
Outcomes

PICO 40.4

Population
Women at term
Intervention
Laminaria tent
Comparator
Oxytocin
Outcomes

PICO 40.4

Population
Women with prelabour rupture of membranes at term
Intervention
Caulophyllum
Comparator
Placebo
Outcomes

PICO 40.5

Population
Women at term
Intervention
Laminaria tent plus oxytocin
Comparator
Oxytocin alone
Outcomes

PICO 40.6

Population
Women at term
Intervention
Balloon catheter (Foley or Atad)
Comparator
placebo/no treatment
Outcomes

PICO 40.7

Population
Women at term
Intervention
Balloon catheter (Foley or Atad)
Comparator
Prostaglandins
Outcomes

PICO 40.8

Population
Women at term
Intervention
Balloon catheter (Foley or Atad) plus prostaglandins
Comparator
Prostaglandins alone
Outcomes

PICO 40.9

Population
Women at term
Intervention
Balloon catheter (Foley or Atad)
Comparator
oxytocin
Outcomes

PICO 40.10

Population
Women at term
Intervention
Foley plus oxytocin
Comparator
Misoprostol
Outcomes

PICO 50.1

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol
Comparator
oral misoprostol
Outcomes

PICO 50.1

Population
Women with uncomplicated twin pregnancy at or near term
Intervention
Elective induction of labour at 37 weeks
Comparator
Expectant management
Outcomes

PICO 50.2

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol - 6-hourly
Comparator
12-hourly dosing interval
Outcomes

PICO 50.3

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol
Comparator
Gemeprost (PGE1)
Outcomes

PICO 50.4

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol
Comparator
Prostaglandin E2
Outcomes

PICO 50.5

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol
Comparator
PGF2alpha
Outcomes

PICO 50.6

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol
Comparator
vaginal misoprostol and laminaria
Outcomes

PICO 50.7

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Combined oral and vaginal misoprostol
Comparator
vaginal misoprostol alone
Outcomes

PICO 50.8

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Combined oral and vaginal misoprostol
Comparator
oral misoprostol alone
Outcomes

PICO 50.9

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Sublingual misoprostol
Comparator
vaginal misoprostol
Outcomes

PICO 50.10

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Sublingual misoprostol
Comparator
oral misoprostol
Outcomes

PICO 50.11

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Sublingual misoprostol 100 mcg
Comparator
sublingual misoprostol 200 mcg
Outcomes

PICO 50.12

Population
Women with a fetal anomaly or after intrauterine fetal death
Intervention
Vaginal misoprostol - low (< 800 mcg cumulative dose)
Comparator
moderate (800 mcg -2400 mcg cumulative dose)
Outcomes

PICO 60.1

Population
Women at term
Intervention
Membranes sweeping
Comparator
No treatment
Outcomes